<div class="form-horizontal">
       <h2>Online Order.</h2>
        <hr />
        <div id="MainContent_ctl00" class="text-danger" style="display:none;">

</div>
<form action="Order/GetOrder.php" method="post">
        <fieldset>
            <legend>Medicine Detail</legend>
            <div class="form-group">
                <div style="float:initial;margin-left:200px">
                    <div style="display: inline-block;">
                        <span style="display:inline-block;font-weight:bold;width:350px;">Medicine Name :</span>
                    </div>
                    <div style="display: inline-block;">
                        <span style="display:inline-block;font-weight:bold;width:150px;">Power (in mg):</span>
                    </div>
                    <div style="display: inline-block;">
                        <span style="display:inline-block;font-weight:bold;width:150px;">Company:</span>
                    </div>
					<div style="display: inline-block;">
                        <span style="display:inline-block;font-weight:bold;width:100px;">Quantity:</span>
                    </div>
					<div style="display: inline-block;">
                        <span style="display:inline-block;font-weight:bold;width:150px;">Type:</span>
                    </div>
                    <div id="answersmain">
                        <div class="answerDiv">
                            <div style="display: inline-block; margin-top: 10px">
                                <input type="text" class="form-control medicine" style="width: 350px" name="medicine[]" />
                            </div>
							<div style="display: inline-block; margin-top: 10px">
                                <input type="text" class="form-control medicine" style="width: 150px" name="power[]" />
                            </div>
							<div style="display: inline-block; margin-top: 10px">
                                <input type="text" class="form-control medicine" style="width: 150px" name="company[]" />
                            </div>
                            <div style="display: inline-block; margin-top: 10px">
                                <input type="text" class="form-control" style="width: 100px" name="quantity[]" />
                            </div>
                            <div style="display: inline-block; margin-top: 10px">
                                <select name="type[]" class="form-control">
                                    <option value="Tablets">Tablets</option>
                                    <option value="Sachet">Sachet</option>
                                    <option value="Bottle">Bottle</option>
                                </select>
                            </div>
                        </div>
                    </div>
                    <br />
                    <img src="Images/add.gif" id="addMore" alt="Add More" />
                    (add more)
                </div>
            </div>
        </fieldset>
        <fieldset>
            <legend>Delivery Detail</legend>
            <div class="form-group">
                <label for="EmailAddress" class="col-md-2 control-label">Email Address</label>
                <div class="col-md-10">
                    <input name="EmailAddress" type="email" id="EmailAddress" class="form-control" />
                    <span id="ctl05" class="text-danger" style="visibility:hidden;">Email Address field is required.</span>
                </div>
            </div>
            <div class="form-group">
                <label for="MobileNumber" class="col-md-2 control-label">Mobile Number</label>
                <div class="col-md-10">
                    <input name="MobileNumber" type="text" id="MobileNumber" class="form-control" />
                    <span id="ctl07" class="text-danger" style="visibility:hidden;">Mobile Number field is required.</span>
                </div>
            </div>
            <div class="form-group">
                <label for="address" class="col-md-2 control-label">Address </label>
                <div class="col-md-10">
                    <textarea name="Address" rows="2" cols="20" id="Address" class="form-control">
</textarea>
                    <span id="ctl09" class="text-danger" style="visibility:hidden;">Address is required.</span>
                </div>
            </div>
        </fieldset>
        <div class="form-group">
            <div class="col-md-offset-2 col-md-10">
                <input type="submit" name="btnOrder" value="Place Your Order" onclick="javascript:" id="btnOrder" class="btn btn-primary btn-large" />
				<input type="reset" name="btnReset" value="Clear Form" onclick="javascript:return window.confirm('Are you sure to clear?');" id="btnReset" class="btn btn-primary btn-large" />
            </div>
        </div>
</form>
		<script>
        $(document).ready(function () {
            $(document).on('click', "#addMore", function (event) {
                var clone = $(".answerDiv").first().clone();
                clone.append('<a href="#" class="removeAnswer"><i><img src="Images/delete.png"/></i></a>').hide();
                clone.find(".form-control").val('');
                clone.appendTo($("#answersmain")).slideDown();
            });
            $(document).on('click', '.removeAnswer', function (event) {
                $(this).parent().slideUp(200, function () { $(this).remove(); });
                return false;
            });
        });
    </script>
